I have been a health insurance broker for over a decade and every day I read more and more “horror” stories that are posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses and physicians not getting reimbursed for medical services. Unfortunately, insurance companies are driven by profits, not people (albeit they need people to make profits). If the insurance company can find a legal reason not to pay a claim, chances are they will find it, and you the consumer will suffer. However, what most people fail to realize is that there are very few “loopholes” in an insurance policy that give the insurance company an unfair advantage over the consumer. In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving the policy holders 10-days (a 10-day free look period) to review their policy. Unfortunately, most people put their insurance cards in their wallet and place their policy in a drawer or filing cabinet during their 10-day free look and it usually isn’t until they receive a “denial” letter from the insurance company that they take their policy out to really read through it. The majority of people, who buy their own health insurance, rely heavily on the insurance agent selling the policy to explain the plan’s coverage and benefits. Don’t you think it would be better to put that extra $200 ($2,400 per year) in your bank account, just in case you may have to pay your $2,500 deductible or buy a $12 Amoxicillin prescription? Isn’t it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?

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In case you don’t know, health insurance is a type of assurance that is given based on agreed terms in case the insured person falls sick or needs medical treatment. The insured life may have a chronic condition requiring medical care for years to come. Let’s know more about it. Who will pay for the medical expenses?This is one of the most common questions that people ask. If you have a health insurance, you can have the peace of mind that your health will be taken care of. Actually, it is a type of agreement or contract between you (policyholder) and the company providing health insurance. The purpose of the agreement or contract is to provide protection against costs. At times, the costs are so high that the sick person is unable to pay the bills. As a result, the person is unable to get the care he needs to recover. While you will pay a monthly or annual premium, you should expect that the amount of premium you are going to pay would be far less than the amount you would pay in case of illness. Keep in mind that health insurance is a type of benefit that a non-profit organization, private business or a government agency provides. In order to figure out the cost, the company gets an estimate of the collective medical cost of all of the people in the state. Then the risk is divided among the policy subscribers. As far as the concept goes, the insurer knows that one person may suffer from huge unexpected health care expenses while the other person may incur no expenses at all. So, the expense is spread across a large group of people in an effort to make the health insurance much more affordable for all the insured lives. Aside from this, public plans are funded by the government. Therefore, they offer extra health insurance to the vulnerable groups like people with disabilities and seniors. Let’s take an example to understand the concept better. A person with Cerebral Palsy needs special treatment through their lifespan. It’s understood that a chronic illness costs a lot more money than a standard care. Cerebral Palsy may result in a physical impairment that may last for the whole life of the sufferer. The treatment for this condition may require regular doctor visits, many therapies and long hospital stays. Based on the degree of impairment, you may need special health insurance. Many health care professionals will involve, such as vocational therapists, occupational therapists, physical therapists, orthopedic surgeons, radiologists, pediatrician, neurologists and so on. Some patients may need the services of more than one. Some may even need a speech pathologist, registered dietician, cosmetic dentists or urologist, to name a few. So, the coverage offered can help you get some relief as far as the burden of the expenses is concerned. If you don’t sign up, you may suffer from a lot of financial strain and you may need help from other sources like charity organizations and community groups. Therefore, it’s a good idea to benefit from a health insurance.

I have been a health insurance broker for over a decade and every day I read more and more "horror" stories that are posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses and physicians not getting reimbursed for medical services. Unfortunately, insurance companies are driven by profits, not people (albeit they need people to make profits). If the insurance company can find a legal reason not to pay a claim, chances are they will find it, and you the consumer will suffer. However, what most people fail to realize is that there are very few "loopholes" in an insurance policy that give the insurance company an unfair advantage over the consumer. In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving the policy holders 10-days (a 10-day free look period) to review their policy. Unfortunately, most people put their insurance cards in their wallet and place their policy in a drawer or filing cabinet during their 10-day free look and it usually isn't until they receive a "denial" letter from the insurance company that they take their policy out to really read through it. The majority of people, who buy their own health insurance, rely heavily on the insurance agent selling the policy to explain the plan's coverage and benefits. This being the case, many individuals who purchase their own health insurance plan can tell you very little about their plan, other than, what they pay in premiums and how much they have to pay to satisfy their deductible. For many consumers, purchasing a health insurance policy on their own can be an enormous undertaking. Purchasing a health insurance policy is not like buying a car, in that, the buyer knows that the engine and transmission are standard, and that power windows are optional. A health insurance plan is much more ambiguous, and it is often very difficult for the consumer to determine what type of coverage is standard and what other benefits are optional. In my opinion, this is the primary reason that most policy holders don't realize that they do not have coverage for a specific medical treatment until they receive a large bill from the hospital stating that "benefits were denied." Sure, we all complain about insurance companies, but we do know that they serve a "necessary evil." And, even though purchasing health insurance may be a frustrating, daunting and time consuming task, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a fair price. Dealing with small business owners and the self-employed market, I have come to the realization that it is extremely difficult for people to distinguish between the type of health insurance coverage that they "want" and the benefits they really "need." Recently, I have read various comments on different Blogs advocating health plans that offer 100% coverage (no deductible and no-coinsurance) and, although I agree that those types of plans have a great "curb appeal," I can tell you from personal experience that these plans are not for everyone. Do 100% health plans offer the policy holder greater peace of mind? Probably. But is a 100% health insurance plan something that most consumers really need? Probably not! In my professional opinion, when you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and price. Just like you would do if you were purchasing options for a new car, you have to weigh all these variables before you spend your money. If you are healthy, take no medications and rarely go to the doctor, do you really need a 100% plan with a $5 co-payment for prescription drugs if it costs you $300 dollars more a month? Is it worth $200 more a month to have a $250 deductible and a $20 brand name/$10 generic Rx co-pay versus an 80/20 plan with a $2,500 deductible that also offers a $20 brand name/$10generic co-pay after you pay a once a year $100 Rx deductible? Wouldn't the 80/20 plan still offer you adequate coverage? Don't you think it would be better to put that extra $200 ($2,400 per year) in your bank account, just in case you may have to pay your $2,500 deductible or buy a $12 Amoxicillin prescription? Isn't it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?